Stomach MCQ Question Bank For MCH and NEET SS ,INI SS Ace Your Medical Exam

Answer: b

Explanation: Roux-en-Y is preferred to prevent bile reflux. A Roux limb (~60 cm) reduces symptoms like epigastric pain, bilious vomiting, and weight loss. HIDA scan can confirm diagnosis.

Ref: Sabiston, SKF

b) Roux-en-Y gastrojejunostomy

Teaching Points:

• Roux-en-Y gastrojejunostomy: Diverts bile and pancreatic secretions away from stomach remnant, relieving symptoms. Gold standard for severe symptomatic cases.
• Conversion to Billroth II: Gastrojejunostomy without Roux limb; bile reflux often persists or worsens.
• Total gastrectomy: Reserved for refractory cases or malignancy; high morbidity if stomach remnant is otherwise healthy.
• Conservative management: PPIs, sucralfate, prokinetics may temporarily relieve symptoms but do not treat underlying bile reflux.

Take-Home Points:

• Alkaline reflux gastritis occurs due to reflux of duodenal contents into stomach remnant post-gastrectomy.
• Symptoms: epigastric pain, nausea, vomiting, weight loss; Endoscopy shows bile pooling and mucosal inflammation.
• Definitive treatment: Roux-en-Y gastrojejunostomy.
• Conservative treatment is only for mild symptoms or temporary relief.
• Conversion to Billroth II may worsen reflux and should be avoided.

c) Distal gastrectomy

Teaching Points:

• Type I gastric ulcer: Located on the lesser curvature (body/antrum).
• Endoscopic failure: Persistent bleeding requires surgery.
• Wedge resection: Not suitable for lesser curvature ulcers; may compromise blood supply.
• Oversewing the vessel: Only temporary hemostasis; high risk of recurrence.
• Distal gastrectomy: Removes ulcer completely; first-line surgical option for Type I ulcers.
• Distal gastrectomy with vagotomy: Reserved for recurrent ulcers or high acid states; not routine for first-time bleeding Type I ulcer.

Take-Home Points:

• Surgery is indicated for bleeding gastric ulcers unresponsive to endoscopic therapy.
• Type I ulcers (lesser curvature) → distal gastrectomy is preferred.
• Wedge resection or oversewing is insufficient for preventing recurrence.
• Vagotomy is not routinely required unless there is a history of recurrent or acid-related ulcers.

Teaching Points:

• H. pylori is a gram-negative, microaerophilic, spiral-shaped bacterium.
• Transmitted mainly by person-to-person (oral–oral or fecal–oral) routes.
• Infection is common in developing countries and low socioeconomic groups.
• Prevalence is low in developed nations due to improved hygiene.

Take-Home Points:

• H. pylori → Gram-negative, microaerophilic organism causing chronic gastritis and peptic ulcer disease.
• Transmission: Person-to-person.
• Common in developing, low socioeconomic populations.
• “Highest infectivity in developed world” is incorrect.

d) Peptide YY

Teaching Points:

• Gastrin: Secreted by G cells in antrum and duodenum; stimulates acid secretion.
• Motilin: Secreted by M cells in duodenum and jejunum; increases GI motility.
• Somatostatin: Secreted by D cells in stomach, duodenum, and pancreas; inhibits other GI hormones.
• Peptide YY: Secreted by L cells in ileum and colon; not secreted in duodenum.

Take-Home Points:

• Duodenal hormones: Gastrin, CCK, Secretin, Motilin, Somatostatin.
• Peptide YY → released from ileum and colon (distal gut).
• PYY slows gastric emptying and inhibits pancreatic secretion.
• Understanding secretion sites helps in GI physiology and surgery exams.

a) Diverticulectomy

Teaching Points:

• Bleeding duodenal diverticulum → rare cause of upper GI bleeding.
• Initial management: Endoscopic or angiographic control.
• Persistent/recurrent bleeding → surgical intervention required.
• Diverticulectomy is the definitive surgical treatment.
• Diverticulization is indicated in perforation, not in bleeding.
• Diverticulopexy and subtotal diverticulectomy are not standard for bleeding control.

Take-Home Points:

• Bleeding duodenal diverticulum → treat endoscopically first; surgery if uncontrolled.
• Diverticulectomy with primary duodenal closure is preferred.
• Ensure duodenal repair integrity and drainage postoperatively.
• Diverticulization reserved for duodenal perforations, not bleeding.